Prevalence and factors associated with use of contraceptives among women aged 15 to 49 years attending various health facilities in Moroto municipality, Uganda

Abstract

Background: Family planning remains the low cost, high dividend investment option for addressing high Total Fertility Rate, high school drop-out rates as a result of teenage pregnancy and high Maternal Mortality Ratio. In Karamoja sub-region, knowledge of contraceptive methods (any method) is 98.4%. Despite this, the sub-region has had historically high fertility levels and low contraceptive use. The aim of the study was to examine the prevalence and factors associated with use of contraceptives among women of reproductive-age attending out patients’ department (OPD) in various health facilities in Moroto Municipality, Karamoja sub-region, so as to provide insights that can aid in addressing challenges of contraceptive non-use in the area. Methods: A cross-sectional study using quantitative and qualitative methods of data collection. A questionnaire was administered, in face-to-face interviews, to 383 randomly selected women of reproductive-age aged 15 to 49 years attending outpatient department (OPD) in the six selected government health facilities in Moroto Municipality. Data was collected on contraceptive use; socio-demographic issues; knowledge about family planning, services and benefits; attitudes, beliefs and practices; partner support; decision making; and the method information index. In-depth Interviews were conducted among 24 purposively selected women. Quantitative data was cleaned using EpiData 3.1 and exported to STATA 15.0 for analysis. Chi square, modified Poisson regression model, 95% confidence interval and p-value set at 0.05 were used to determine the statistical significance of the associations between independent variables and contraceptive use. Qualitative data was transcribed, coded and analysed manually using thematic analysis. Results: The prevalence of contraceptive use in Moroto Municipality was 59.2%. The prevalence of traditional contraceptive use was 7.6% and that of modern contraceptive use was 51.6%. Individuals with varying numbers of siblings exhibited differences in the likelihood of utilizing traditional contraceptive methods. They all exhibited a decreased likelihood of adopting traditional contraceptive methods, 1-2 siblings (AOR 0.30 (0.10-0.89)); 3-4 siblings (AOR 0.10 (0.02-0.50)) or 5 and above siblings (AOR 0.24 (0.06-0.89)). On the other hand, respondents with no education (AOR 0.27 (0.11-0.67)); an average monthly income of UGX 500,000 and above (AOR 0.58 (0.36-0.94)); or in a polygamous relationship (AOR 0.60 (0.41-0.87)) were less likely to use modern contraceptives. Whereas, respondents who were peasants (AOR 2.02 (1.17-3.47)) or students (AOR 1.72 (1.05-2.80)) were more likely to use modern contraceptives. Also, the lived experiences of the respondents were found to influence their use of contraceptives. From the analysis, these experiences were categorized as positive or negative. Conclusion: Despite the increased prevalence of contraceptive use in Moroto Municipality from 7.0% in UDHS 2016 to 51.6% in this study, the unmet need for contraceptives is still high. There is also a preference for modern contraceptive methods, specifically the hormonal contraceptives such as injectables and contraceptive pills. There is need for health stakeholders to focus on these factors while promoting contraceptive use. Women’s experiences in contraceptive use influence their contraceptive decisions and have implications that are key to increasing contraceptive prevalence.